Following a hypoxic episode, the acute cerebral insult most typically involves the gray matter followed by some degree of clinical recovery. Some patients may demonstrate a different course. These patients suffer a delayed second neurological decline 2-3 weeks after the initial insult, followed by clinical recovery. During the period of the delayed neurologic decline, magnetic resonance imaging (MRI) will show findings of leukoencephalopathy. This uncommon presentation has been named reversible delayed posthypoxic leukoencephalopathy (RDPHL). Although it is rare, this is an important clinical entity because the etiology of new neurological symptoms can be confusing to clinicians several weeks after the initial hypoxic insult. Recognition of this entity is important, as it is associated with good neurological recovery.There have been numerous prior studies and case series of patients presenting with acute anoxic/hypoxic injuries and the various findings associated with these patients. However, there have only been a few prior case reports of individual patients with RDPHL [1-6].
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